Depersonalization and Derealization
Type: Transitory aura symptom — typically develops gradually over 5–20 minutes and resolves within 60 minutes.
What is it?
Depersonalization and derealization are two related but distinct feelings of unreality that can occur during migraine aura. Depersonalization is feeling detached or disconnected from yourself — as though you’re observing your own thoughts, feelings, or body from outside. Derealization is the sensation that the world around you is unreal, distant, or dreamlike — as if you’re viewing reality through a screen or from a great distance. These are purely subjective perceptual experiences; your connection to yourself and the world remains intact.
What it feels like
At the onset, you might describe the experience as feeling “not real.” Your surroundings take on a dreamlike quality, sometimes described as seeing the world “projected on a screen.” Your body may feel foreign or as though it belongs to someone else. There’s often a profound sense of strangeness and detachment that can be deeply unsettling. You may also experience accompanying symptoms like dizziness, visual disturbances, or weakness on one side of your body. The feeling is disorienting but always temporary — it resolves within an hour and leaves no lasting effect on your sense of self or reality.
How patients describe it
“I get these little ‘weak’ spells (which the docs say are ‘panic attacks’) where I feel like I’m going to faint but never do… I’ve also had the ringing in my ears, off and on, for over a decade… I’ve also had weakness on one side, the weird ‘depersonalization’ feelings, dizziness and near fainting feelings.” — S.
“I get derealization/depersonalization when I have a migraine…” — J.
“My migraine experience starts with hunger. I suddenly feel hungry. Shortly after that my vision becomes ‘distant’. It is somewhat like seeing the world projected on a screen. The actual experience is not that obviously artificial, but that is the closest that I can come to conveying the feeling.” — A.W.
Related symptoms
- Visual symptoms (scotomas, flashing lights)
- Weakness or numbness on one side of body
- Dizziness or vertigo
- Speech difficulties
Clinical note
Depersonalization and derealization can feel alarming because the sensation of unreality is so unusual. These symptoms are well-documented in migraine with aura and always resolve completely. However, because they can occasionally occur with other neurological conditions, medical evaluation is warranted if they are new, severe, or occur without other typical migraine symptoms. Reassurance that these sensations are temporary and harmless is often the most important treatment.
If this is the first time you experience these symptoms, or they feel different from previous episodes, seek medical evaluation to rule out other causes.